By Laura Redman
(Published in the Digby Courier)
Like his new colleagues, Dr. David LaPierre has only been associated with Digby since September, but he and others have already helped form a collaborative practice with two other doctors, three nurse practitioners and a family practice nurse.
“We know we don’t yet have the capacity to care for all of the people in the Digby community, but one of the central value questions is: How can we, together, create an environment where we can recruit and retain primary care providers?”
Dr. LaPierrre said the collaborative team practice approach is a fairly new way of thinking for the Nova Scotia Health Authority (NSHA) and is in response to unmet health-care demands in rural Nova Scotia. The co-practice offers a team environment for family physicians instead of a solo practice that has been found to be overwhelming when the community need is so great.
NSHA has defined a collaborative team practice as a group of three or more health-care providers, from at least two different disciplines. The guiding principles NSHA has developed state the practice facilitates “a coordinated, integrated and comprehensive team approach to patient care; be focused on patient and community health outcomes; respect open communication, autonomous judgment and shared decision-making.” Nova Scotia now hosts 50 collaborative practices.
The current Digby-based team operates out of the Digby and Area Health Services Centre and, in addition to LaPierre, includes new family physicians Dr. Jennifer Chang and Dr. Genna Bourget. Dr. LaPierre is convinced this team approach is the direction physicians need to take, and while he’s open about the challenges, he’s also really upbeat about the future of health care in Digby.
“I know the emergency closures continue to be a problem, but we’ve taken great strides and I think we need to keep taking great strides to really come together,” Dr. LaPierre said. “We also need to call the challenges what they are, and honestly I see the challenges every day. The stories I hear are heartbreaking, they truly are, but I’m so motivated by this situation in Digby, and for us as a team to share our perspective, our passion and our ideas is essential to this situation. We need to keep working together, as a community, to improve this environment.”
Dr. LaPierre said he was pleased the media was mitigating some of the tough questions.
“I really appreciate the role of media in our society,” Dr. LaPierre said, although he cautioned that there is another side to the health-care story.
“Let’s talk about the tough stuff, but let’s also talk about the good news, because there’s going to be lots of good news happening in 2018," Dr. LaPierre says.
HEALTH CARE PERSPECTIVES
Dr. Jennifer Chang, a new young doctor who is part of the collaborative, was also available last week to provide her perspective on the state of health care in Digby. She noted that besides her clinic work, she works in palliative care, has done home visits and works regular shifts in the emergency department. She spoke to the frequent closures the Digby General Hospital’s emergency department and the NSHA usage of the language citing “physician availability.”
“I don’t feel blamed,” Dr. Chang said. “But I can see how people can draw that conclusion from the wording that’s used. The reality is we still don’t have enough bodies. Everyone is already working as much as they can and there have been a few physicians who have retired in recent years or moved away.
“But we still have a few doctors who are putting all of their time and energy into trying to cover whatever shifts we can here in Digby – it’s their tireless work that keeps the emergency open.”
She said the decision to close the emergency department overnight is always a tough one.
“It’s not something any of us ever wants to happen,” she said. “It’s just that there literally isn’t anyone available. We try to change shifts around so it doesn’t happen, but sometimes it still does.”
When given the example of the concerns of a person living on Digby Neck who suffers a heart incident and the Digby hospital emergency department is closed, Dr. Chang said she deeply appreciates the public’s concerns, but added that, unfortunately, that’s the reality of rural medicine in Canada.
“Sadly, that’s the reality of today’s world, even with all of the medical advances we have in our hands. In a perfect world, we’d all be near a huge hospital with a cath lab – that’s the gold standard for treatment for a heart attack – but that only exists in Nova Scotia in Halifax and in New Brunswick, it’s only available in Saint John, one place in each of the Maritime provinces. So if you’re not living in Halifax, technically you’re not receiving the gold standard of health care,” she said.
IN EMERGENCY SITUATIONS
Dr. LaPierre said in emergency situations, he hopes people are calling 911 immediately and using the pre-emergency system effectively. However, Dr. LaPierre also urged residents to use the 811 system that connects callers to a registered nurse who can answer questions and offer advice about more minor ailments. As for the services that have moved out of the Digby hospital in recent years, he said he wasn’t concerned.
“As a physician in this rural general hospital, I am still able to order x-rays, ultrasounds, blood work – those are all services that are readily available to me here,” Dr. LaPierre said. “I think it’s okay for a rural hospital not to have a CT scanner or an MRI because we’re not ordering those services every day and having them available regionally just makes sense.
“We can still do minor surgeries here in Digby and I really think it’s important to note that we’re not alone – we have excellent specialist support in Kentville and in Yarmouth by phone. So whenever I’m up against a tough situation, I’m able to very quickly call my specialist colleagues who are very responsive and we can make a plan together about either managing the patient in Digby or transporting them if their acuity is beyond Digby,” LaPierre said. “I’m proud of the Digby hospital. I think it’s great and it’s also great that it’s right next to the clinic, so we can maintain really strong relationships with all of the great people who are working in the hospital.”
He reiterated his positive thoughts for the coming year.
“I have to say, I’m looking forward to 2018,” he said. “We’ve come together, we have a strong team and a strong foundation. It’s still a fragile situation, but I think there is great strength in what is happening. I know it’s not flowers and rainbows, but I’m really optimistic about what 2018 is going to hold.”
He hopes past issues will soon be relegated to the past for all residents of Digby.
“There’s been a number of providers who have come and gone,” Dr. LaPierre said. “That’s a big part of the reason we’re in this current situation. So we’ve committed initially to continue to provide care to people whose providers have come and gone. We felt that was the fair thing to do, the right thing to do.”
OPTIMISTIC ABOUT THE FUTURE
When asked why he is so optimistic about the future, Dr. LaPierre didn’t hesitate to respond.
“Because Digby is a beautiful place – it’s gorgeous – the people are wonderful, so there is no reason geographically that Digby shouldn’t be able to recruit people,” he said. “So that’s number one, the beautiful place, number two is the critical mass of staff we’ve now created – physicians have struggled in the past without having that critical mass because the need is very large and it’s easy for an individual to get overwhelmed. And number three is the dialogue that is now happening with different groups in the community coming together with the health-care team. We have tough conversations, but that’s fine. When things are talked about sometimes it’s tough, but I think it’s all very positive. The culture here is moving in the right direction in terms of our ability to have those dialogues.
“I’m really sensing mutual respect, mutual trust and openness and I think that’s the biggest advantage that really gives me optimism – you have to have that level of trust and respect between all of the different groups in order to recruit and retain providers, and I think that’s happening more and more. That’s a wonderful thing.”
Dr. Chang said some of the critical support for creating their team came from the health-care providers already in the community – namely Dr. John Black and Dr. Marek Bander.
“They’ve been here for many, many years and they’re pillars here in the health care of this community,” Dr. Chang said. “They’ve been really helpful to us in getting settled and in feeling supported and that’s been so important to us. We’re so grateful to them.”
Dr. LaPierre jumps back into the conversation.
“I want to underline that statement,” He said. “We need to celebrate their mentorship and their welcome to the community. It’s been a critical part of our current success.”
He said the new collaborative practice team is also supporting recruiting efforts and is taking a proactive approach in communications with the launch of a new website – digbyhealthhome.ca . The website offers clinic times, updated information about physician availability and a special page for recruitment purposes.
“We think it’s important for people to know what’s happening and why it’s happening,” Dr. LaPierre said. “It’s great to speak directly to people, but it’s also helpful to use a website to describe the way things are at this point and what we’re hoping to grow towards.”
Dr. Chang said she is on a three-year contract in Digby and, ultimately, she said she believes the best way to recruit doctors to rural areas like Digby is to grow them in the community.
“I think the best way to attract and retain physicians is if the physician comes from the area originally,” she said. “People tend to gravitate back to where they came from, because when they have kids, they want their parents around. Little things like that make a big difference – and, of course, having jobs available for the spouse as well.”
That being said, she admitted she’s originally from Toronto, but has no plans to go back.
“Once you live in the Maritimes, it’s hard to go back.”
Dr. Chang said she and her practice partners are also actively engaged in recruiting more health-care workers to Digby.
“We’re talking to medical students who live in the area – and high school students who are considering medicine, because we want Digby to thrive and we want doctors who come to Digby to stay forever,” Dr. Chang said. “I know those are more long-term solutions, and could take years and years, but we have some other ideas that we’re working on as well.”
Based on her months of experience in Digby, Dr. Chang is also positive about the future, and believes they’ve now established the foundation for an expanded collaborative practice.
“Since Genna and Dave and I started working in September, we have all agreed we enjoy working in Digby,” Dr. Chang said. “The people are so nice and friendly and the hospital staff are great. We’re having a really good experience here. There is lots to do, lots of need, but right now, we can honestly say we’re all doing as much as we can and we’re looking forward to the future.”
For more information about the Digby & Area Health Services Centre, visit digbyhealthhome.ca, where information is posted about clinics, the collaborative practice and accessing health care in Digby and the Islands.